Cuomo: "Everybody wants Hydroxychloroquine to work." He says it's become extremely politicized. Said "maybe it works," but can't confirm. Says if the Federal government gives us more, we will dispense more.
Thread on testing & treatment research for COVID-19
- Thread starter dailybuck777
- Start date
PSU2UNC,
Here is an interesting quote from the article. “Looking just at deaths, 2.8% of the patients who took hydroxychloroquine died, and 4.6% of the patients who did not take it died. That difference was also not found to be statistically significant.” Seems that a 64% difference is substantial. That said the study pool size is very small and doesn’t address diversity of the pool for age, sex, co-morbidity, etc...
PSU_et_vt and jmisdamina,
QT wave form is effected for a period of time while using the therapy and is not permanent. A better description of the effect is in the quote below from the attached article.
“The QT interval in electrocardiograms (ECG) is the time from the beginning of the QRS complex, representing ventricular depolarization, to the end of the T wave, resulting from ventricular repolarization.[8]
In general, the normal QT interval is below 400 to 440 milliseconds (ms), or 0.4 to 0.44 seconds. Women can have a longer QT interval than men. Due to the effects of heart rate, the corrected QT interval (QTc) is frequently used.
Due to the effects of heart rate, the term "corrected QT interval" (QTc) is frequently used. The QTc is considered prolonged if greater than 450 ms in males and 470 ms in females.[8]”
https://www.dicardiology.com/articl...eatment-brings-prolonged-qt-arrhythmia-issues
Here is an interesting quote from the article. “Looking just at deaths, 2.8% of the patients who took hydroxychloroquine died, and 4.6% of the patients who did not take it died. That difference was also not found to be statistically significant.” Seems that a 64% difference is substantial. That said the study pool size is very small and doesn’t address diversity of the pool for age, sex, co-morbidity, etc...
PSU_et_vt and jmisdamina,
QT wave form is effected for a period of time while using the therapy and is not permanent. A better description of the effect is in the quote below from the attached article.
“The QT interval in electrocardiograms (ECG) is the time from the beginning of the QRS complex, representing ventricular depolarization, to the end of the T wave, resulting from ventricular repolarization.[8]
In general, the normal QT interval is below 400 to 440 milliseconds (ms), or 0.4 to 0.44 seconds. Women can have a longer QT interval than men. Due to the effects of heart rate, the corrected QT interval (QTc) is frequently used.
Due to the effects of heart rate, the term "corrected QT interval" (QTc) is frequently used. The QTc is considered prolonged if greater than 450 ms in males and 470 ms in females.[8]”
https://www.dicardiology.com/articl...eatment-brings-prolonged-qt-arrhythmia-issues
The study is generally negative towards Hydroxychloroquine, but the actual results were somewhat positive. For instance, "Looking just at deaths, 2.8% of the patients who took hydroxychloroquine died, and 4.6% of the patients who did not take it died. That difference was also not found to be statistically significant."
For the more statistically knowledgeable people here, I am curious as to why this would be insignificant. Nearly a halving of the death rate would be significant to me. I know they have probability error bars, but this is something that merits more research and not arm waving to me.
Later edit minutes after post. Wrote my post while jwa did his. Sorry for the repetitious part, but my post, partly, has a different angle than jwa.
For the more statistically knowledgeable people here, I am curious as to why this would be insignificant. Nearly a halving of the death rate would be significant to me. I know they have probability error bars, but this is something that merits more research and not arm waving to me.
Later edit minutes after post. Wrote my post while jwa did his. Sorry for the repetitious part, but my post, partly, has a different angle than jwa.
Does anyone know how these heart-related side effects are managed with lupus and rheumatoid arthritis patients? These drugs are apparently used frequently enough that there were major concerns about those existing patients not having access to these medications if they were used for COVID-19 patients instead. The supply concerns were serious enough that some limits were placed on the use of these medications for COVID patients. What is different about the side effects for these existing patients?
Thanks.
As for the heart risk found in the Brazilian study...
Isn't COVID-19 causing heart damage as well? Is it worse with or without the drugs? Just curious.
My Mom is 80 and has RA for many years and is prescribed 200mg Hydroxychloroquine daily. She is required to visit the Ophthalmologist yearly, for a retinopathy evaluation, which can occur with high doses of medication or greater than 5 years use of the medication. I have never heard of heart related issues that she is screened for because of the meds.
Article below. Interesting that it is no longer used for malaria, as it developed immunity to the drug
https://www.rcophth.ac.uk/wp-content/uploads/2017/07/Patient-information-leaflet-draft-1.pdf
I would assume the difference is within the margin of error, that is the most simple explanation.
There is much less cardiac stress for a person with lupus under control than one on a vent with double pneumonia caused by a severe infection. The cardiac issues with HQ would be much more of a problem with C19.
The Vanderbilt research appears to be HQ only, no mention of zinc or erythromycin. Perhaps that is just the editor/writer but if so it is disappointing as most say you need the combo for success.
It is common in scientific papers to see differences that seem qualitatively important but are not statistically significant. In other words, we cannot say for sure that this pattern is "real" or if it is a mirage (i.e. essentially an artifact of the data).
Statistical significance (or lack thereof) is generally driven by sample size and variability. If you have a very large sample size or very small variability, it is possible to detect relatively small differences between statistical populations.
Biomedical studies tend to suffer from both of these issues; it is difficult to do large scale studies (expense), which is compounded by the fact that it is impossible to control for both genetic and environmental variables within the test subjects.
As I'm sure you are aware from your work, if you cannot say that a finding is statistically significant, you cannot be sure if that pattern is real, or just a function of variability with the experimental population. You cannot exclude the possibility that this treatment could work, but the current data does not show that it is effective.
Chi, please stop posting HCL or CQ only studies, we get it, and we called this days ago that these articles would start coming out. What would be meaningful would be combo studies and anectodotes, that is what is in question, especially relevant is the triple combo. Let the chips fall where they may with that, but unfortunately these HCL only articles are nothing but political.
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The HCQ group (n=84) resulted in 3 deaths while the non-HCQ group (n=97) resulted in 4 deaths. This is 3.6% death in HCQ group and 4.1% death in non-HCQ group. The 2.8% and 4.6% quoted in the article are the weighted proportions from each group. It is easier to see why no statistical difference when looking at the raw data.
Further, the paper notes that the HCQ and non-HCQ group were well-balanced, but it is notable the non-HCQ group had a higher percent for each listed co-morbidity except liver cirrhosis.
HCQ. Non-HCQ
Chronic respiratory issues 5/84 15/97
Chronic heart issues 1/84 5/97
Cardiovascular issues 38/84 56/97
Diabetes 4/84 11/97
Kidney issues 1/84 8/97
Liver cirrhosis 1/84 0/97
Immunodepression 8/84 13/97
So with only one more death in the non-HCQ group given the larger numbers with respiratory, cardiovascular, or heart issues it doesn’t seem like the HCQ group did any better. Certainly nowhere close to saying that the HCQ group had a 60% lower percent of death. The HCQ and non-HCQ groups are closer to be equivalent.
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Thank you for reiterating what I said in my post. Let’s take all the data globally, combine it, comb through it, and segment treatment type and population diversity. Then we can comment on what the study means. The politics have gotten in the way of this entire treatment and people have simply tried to stomp it or support it because of who suggested it.
Everyone seems to be willing to accept that smokers have less a threat of death from COVId19 per one publication, did we hear any uproar about those “facts”. Hmmm seems like and interesting juxtaposition.
Everyone seems to be willing to accept that smokers have less a threat of death from COVId19 per one publication, did we hear any uproar about those “facts”. Hmmm seems like and interesting juxtaposition.
Attempting to link "independent" causal variables (like smoking) are very different from a druge study (hopefully you know that). One is epidemiological and the other experimental. Yes, it is true that we do not know for sure that smoking exacerbates SAR-Cov-2. But we cannot do experiments that test that hypothesis.
PSU2UNC
I know it didn’t seem like what I wrote could be true, but in fact there was a study published about the abnormally low death toll attributed to smokers across the board regardless of comorbidity.
I know it didn’t seem like what I wrote could be true, but in fact there was a study published about the abnormally low death toll attributed to smokers across the board regardless of comorbidity.
Leaving HCQ aside for a second, this is going to be a bigger and bigger story unfortunately. Covid attacks any and all internal organs. Many of the people who survive a severe case will have cardiomyopathy and die from that in coming years.
People will come out of it Type 1 diabetics because their pancreas doesn't work any more. Some have wrecked kidneys and will need dialysis for rest of their life. Even neurological and brain damage. So survival doesn't mean what it usually means for flu -- full recovery. There was a gruesome tweet from a surgeon the other day saying all he's been doing lately is cutting out necrotic (dead) tissue from people.
There's very little data on this -- the focus is just on survival as it should be. And plenty of people, even very sick people, do make a full recovery. But many survivors will have to live with problems.
Three of four countries have noticed this at the macro level. Tobacco smokers seem to be under-represented in the deaths. It hasn't been studied yet -- a question for future years.
I asked a pharma researcher friend about it -- is it possible nicotine is actually helpful? He responded that smoking causes so many changes in the human body, even if tobacco smoking were protective, it would be impossible to tease out why any time soon.
Still, why not add a pack of Camels to the first aid kit along with the quinine, zinc and the horse de-wormer. (just kidding! kidding!)
If you read the actual study in ChiTowns first linked article you may be surprised that 96% of the HCQ test group was with multiple therapeutics. 20% with HCQ + azithromycin (17 of 84 patients) and 76% with HCQ + amoxicillin and clavulanic acid (64 of 84 patients).
If the goal is to be more scientific and less political then it’s best to read the scientific paper.
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Thanks very much for your very good and useful statistical analysis.
NY state predictions and actual. They are now exporting ventilators
I was wondering if with the paralyzed cilia from smoking with the resultant mucous build up, if the mucus somehow acts as a barrier between the virus and the lung alveoli . IDK but I haven’t heard a reason yet .
I’m happy that to the best of my knowledge , we haven’t had a vent shortage anywhere in the USA? Have we ? In Lancaster PA, our hospital hasn’t gone over 16 or so on vents for COVID Pts. We have about 90 vents and 50 anesthesia machines . So we haven’t even come close to a crunch . Hope it stays that way . Max was 16 ish and now at 8 on vents . Gov. W is now mandating that ALL non hospital medical/dental providers send in a detailed list of all PPE, medications , anesthesia machines etc. so they can be confiscated if he deems it so . Gov. Is also now placing some mask and additional requirements on opened businesses. This becomes enforceable 4/19 at 8 pm .NY state predictions and actual. They are now exporting ventilators
And now Ned can make his case....clearly Mike Coudrey has as political angle.
Never heard of him, so I find out he started a sunglasses e-commerce company and then later digital media and real estate companies. Currently, the CEO of Pharos Investment Group and has offered “digital media warfare” services to political candidates.
Trust in unqualified sources at your own choosing
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I know Actemra is in trials right now and has shown some promise helping patients with the dangerous “ cytokine storm “ progression which is more often seen in younger, healthier people experiencing serious COVID.
I saw a story about a former NW football standout from the ‘96 squad now a physician who believes Actemra probably saved his life.
With a theraputic, I think the primary goal needs to be keeping a person out of the hospital and off of a ventilator. The thing about meds is that they don’t all work all of the time for everybody. Meds have a “ number to treat “ which means a dozen people might have to take a given med for one to derive a benefit ( and by the way, a number to treat of 12 is often considered reasonable ! ).
I saw a story about a former NW football standout from the ‘96 squad now a physician who believes Actemra probably saved his life.
With a theraputic, I think the primary goal needs to be keeping a person out of the hospital and off of a ventilator. The thing about meds is that they don’t all work all of the time for everybody. Meds have a “ number to treat “ which means a dozen people might have to take a given med for one to derive a benefit ( and by the way, a number to treat of 12 is often considered reasonable ! ).
Maybe, just maybe, this virus doesn't attack all people 100% the same, and thus different medicines will work different for different people? If all meds worked the same, then we'd only have 1 high BP medicine, 1 cholesterol reducing medicine, 1 ....... Maybe many recover with nothing, but some respond to Actemra, and some respond to hydroxychloroquine, and some respond to the triple therapy, and some respond to Ivermectin, and some respond to skittles up their butt. With this disease and cure, can there really be any all/none/always/never absolute assigned? When I see those words in tweets, I see both ends of the political normal curves hopes and dreams, and not reality.
Hershey Medical Center is participating in Remdesivir clinical trials.
https://www.abc27.com/news/health/c...al-drug-remdesivir-for-treatment-of-covid-19/
Also, here’s a study showing that Remdesivir is effective against SARS-CoV-2, but this study was performed on insect cells in a lab; it DOES NOT PROVE that Remdesivir will work in humans with COVID-19.
https://www.medicalnewstoday.com/ar...s-cov-2#New-evidence-in-support-of-remdesivir
https://www.abc27.com/news/health/c...al-drug-remdesivir-for-treatment-of-covid-19/
Also, here’s a study showing that Remdesivir is effective against SARS-CoV-2, but this study was performed on insect cells in a lab; it DOES NOT PROVE that Remdesivir will work in humans with COVID-19.
https://www.medicalnewstoday.com/ar...s-cov-2#New-evidence-in-support-of-remdesivir
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Well 2-3 weeks ago doctors started realizing that putting people on vents didn't save them for the most part. Still being debated but this is probably very different from a severe flue which those vents were designed for.
ICU protocols have changed a lot as the teams emphasize different treatments -- preventing the tiny blood clots that kill lungs (as well as other internal organs) has become a priority. Some are advocating people taking low-dose aspirin as soon at first sign of symptoms, because it is an anticoagulant. But in the ICUs they are testing for coagulation (D-dimer) and treating aggressively with Heparin etc.
If they can lessen the microthrombosis, sometimes they can just add oxygen through a cannula (nose) or a CPAP which do not require intubating. Intubation adds a lot of risk because of the large amount of anesthesia that has to be used -- you're often putting a patient into a coma.
I am stuck by high level of improvisation, collaboration and scientific ferment that is improving the ICU protocols almost daily.
By contrast, you see almost no scientific discussion about ways to help patients in the early stages. Everybody's so hung up on waiting for RCTs, it's like a big intellectual freeze, and there's no leadership coming from Washington whatsoever.
So while a lot of people think the best chance of fighting the disease is in the early stages, we have almost no ideas (except HCQ and other unproven antivirals).
Lombardy tried to save people with ICUs and vents and had horrific death rates. So they now emphasize early care, when people are still at home. They give them HCQ, broad-spectrum antibiotic and a pulse ox and instructions to use it frequently so if the blood ox drops, they know that's time to come to the hospital. There have been heartbreaking cases in the US (such as that nurse in Florida) who just died in their sleep because they didn't know they were dying. People at home are not getting the care and follow-up they need.
ICU protocols have changed a lot as the teams emphasize different treatments -- preventing the tiny blood clots that kill lungs (as well as other internal organs) has become a priority. Some are advocating people taking low-dose aspirin as soon at first sign of symptoms, because it is an anticoagulant. But in the ICUs they are testing for coagulation (D-dimer) and treating aggressively with Heparin etc.
If they can lessen the microthrombosis, sometimes they can just add oxygen through a cannula (nose) or a CPAP which do not require intubating. Intubation adds a lot of risk because of the large amount of anesthesia that has to be used -- you're often putting a patient into a coma.
I am stuck by high level of improvisation, collaboration and scientific ferment that is improving the ICU protocols almost daily.
By contrast, you see almost no scientific discussion about ways to help patients in the early stages. Everybody's so hung up on waiting for RCTs, it's like a big intellectual freeze, and there's no leadership coming from Washington whatsoever.
So while a lot of people think the best chance of fighting the disease is in the early stages, we have almost no ideas (except HCQ and other unproven antivirals).
Lombardy tried to save people with ICUs and vents and had horrific death rates. So they now emphasize early care, when people are still at home. They give them HCQ, broad-spectrum antibiotic and a pulse ox and instructions to use it frequently so if the blood ox drops, they know that's time to come to the hospital. There have been heartbreaking cases in the US (such as that nurse in Florida) who just died in their sleep because they didn't know they were dying. People at home are not getting the care and follow-up they need.
My daughter has been on hydroxychloroquine for about 15 years (lupus). Most likely she is on a low dose (don't recall dosage as she's been out of the house a number of years) as it's being used as a maintenance drug at this point to continue to suppress her immune system. The only issue we were made aware of by her doctors is possible effects on her retina, so annually she gets a visual field test. Her rheumatologist said years ago that it was a great drug with very limited side effects.
Just saw this today. I have seen a video of a dr who said vents are not working so it may be the one she refers to in the video. He also had mentioned a correlation to altitude sickness.
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Yeah, it's considered a very safe drug which you'd never know from the news coverage. It's been given to tens of millions of people in malarial areas (or people visiting those areas) every year for decades.
When there's decent trial data (this month, next month, june?) there could be a consensus is to stop prescribing HCQ because it doesn't actually help. But there's probably no reason to stop prescribing it because of side effects, because they're manageable.
When there's decent trial data (this month, next month, june?) there could be a consensus is to stop prescribing HCQ because it doesn't actually help. But there's probably no reason to stop prescribing it because of side effects, because they're manageable.
Did you mean to post 'vents aren't working ' ?
Interesting theory. I had heard some one else say C19 was similar to altitude sickness.
The stock market at least thinks that Remdesivir is very promising at this time. Here is Dr. Mullane speaking, "
"When we start [the] drug, we see fever curves falling," Mullane reportedly said. "When patients do come in with high fevers, they do [reduce] quite quickly. We have seen people come off ventilators a day after starting therapy."
"Most of our patients are severe and most of them are leaving at six days, so that tells us duration of therapy doesn't have to be 10 days," she added. "We have very few that went out to 10 days, maybe three." https://www.newsweek.com/remdesivir...l-patients-trial-released-within-week-1498429
Of course, this is info in financial markets and is subject to manipulation. However, it could be good news.
"When we start [the] drug, we see fever curves falling," Mullane reportedly said. "When patients do come in with high fevers, they do [reduce] quite quickly. We have seen people come off ventilators a day after starting therapy."
"Most of our patients are severe and most of them are leaving at six days, so that tells us duration of therapy doesn't have to be 10 days," she added. "We have very few that went out to 10 days, maybe three." https://www.newsweek.com/remdesivir...l-patients-trial-released-within-week-1498429
Of course, this is info in financial markets and is subject to manipulation. However, it could be good news.
